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Aortic Aneurysm
An aneurysm is a bulge in the artery wall. Weakened by atherosclerosis (hardening of the arteries), smoking, hypertension, or other causes, the vessel walls balloon outward with the pressure of the blood flow inside. If an aneurysm bursts, it can cause massive, life-threatening internal bleeding. Other risks include blood clots (possibly leading to a heart attack or stroke) and leakage of blood.
Aneurysms can form in arteries throughout the body but most occur in the aorta. Starting in the heart and continuing through the chest and abdomen to the legs, the aorta is the body's largest blood vessel. If the aneurysm occurs in the lower section of the aorta, it is known as an abdominal aortic aneurysm; if it occurs in the portion of the aorta in your chest, it is called a thoracic aortic aneurysm.
Aneurysms may expand slowly or quickly or they may stay the same size for many years. They often develop without any warning signs. Sometimes, however, people experience symptoms from an aneurysm. These can include:
- A pulsing sensation in the abdomen
- Stomach pain or tenderness
- Back pain
A burst aneurysm is a medical emergency. Signs of a ruptured aneurysm include:
- Sudden, intense pain in the abdomen
- Dizziness
- Sweating
- Low blood pressure
- Fast pulse
If an aneurysm is discovered, it will be monitored closely. Many remain small and never rupture. Large, fast-growing, leaking or painful aneurysms may require surgery. Surgery is performed immediately on aneurysms that threaten imminent rupture or that have already ruptured, although the procedure is less successful once the vessel has burst.
Aortic Treatment
In an endovascular stent-grafting procedure, a small metal cylinder called a stent is implanted in the artery to provide a strong new vessel wall. During the procedure, a thin tube called a catheter is guided up the aorta to the site of the aneurysm. A balloon on the end of the catheter helps fit the stent into place. Then the catheter is removed. The aneurysm generally shrinks around the stent as time passes.
Open aneurysm repair involves making an incision in the abdomen, removing the section of the artery with the aneurysm, and replacing the excised segment with a graft made of a synthetic tube.
Recent minimally-invasive laparoscopic techniques allow surgeons to make very small incisions in the groin to access the femoral artery. A thin tube with a camera is inserted into the artery and threaded up to the aneurysm so the surgeon can "see" inside the patient's body without the need for traditional open surgery.
Periphrial Vascular Surgery
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Central arteries transport blood directly from the heart, while peripheral arteries carry blood everywhere else in the body (head, neck, arms, lower abdomen, legs, feet).
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Peripheral artery disease (PAD) or peripheral vascular disease (PVD) occur when peripheral blood vessels are blocked, hardened and narrowed, a condition known as atherosclerosis. Risk factors for developing vascular disease include:
- Family history of atherosclerosis
- Diabetes
- Obesity
- Smoking
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- High blood pressure
- Exposure to lead and cadmium
- Kidney disease
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Signs that you may have peripheral vascular disease are leg pain that often occurs when exercising and ceases during rest; numbness, coldness, change of color or loss of hair in the legs or feet; muscle pain in the thighs or lower; paleness, blueness or weak or absent pulse in a limb; and an abnormal change in the way you walk.
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Various instruments and tests can detect the presence of vascular disease. These include blood pressure cuffs, Doppler and intravascular (IVUS) ultrasound, angiogram, magnetic resonance imaging (MRI), plethysmogram and venogram.
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Treatment options for PAD/PVD range from lifestyle changes and medications (sclerosing agents or blood thinners) to catheter-based treatments and traditional or endoscopic surgery. Surgery promotes clear blood flow by bypassing a vessel using a graft made of tissue from another undamaged vessel.
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